For many of the 12 million cancer survivors throughout the United States, remaining in the workforce is an important expectation that requires the support and attention of the oncology community. And while continuing employment can be critically important for economic reasons (especially in the current financial climate), it is valued for reasons of fulfillment and self-worth as well.
Employment Obstacles and Facilitators
Although survivors face a number of emotional and medical challenges after cancer treatment, studies show that the expectation to remain in the workforce is not just a wish, but rather, a realistic expectation. In fact, a recent literature review found that, overall, 63.5% of cancer survivors returned to work after treatment.1
As clinicians trying to maximize the functioning of the cancer survivors in our care, we need to understand the factors that affect the ability of a patient with cancer to remain employed after treatment ends, in order to facilitate a return to work. There is no generic formula to offer all cancer survivors wishing to maintain employment. Rather, the workplace challenges depend on the cancer site, the treatment, the patient’s occupational status, and the roles of others, both at home and in the workplace.
In particular, the impact of treatment on work and productivity in the job results from the effects of multimodality therapy on physical, cognitive, and psychosocial functioning, with fatigue and cognitive impairment being the most commonly reported obstacles to returning to a previous level of functioning on the job. The more prolonged and intense the treatment, the longer the absence from the workplace.
But just as there are employment obstacles for cancer survivors who wish to return to work, there are important factors that can facilitate the process. Among the most important of these positive influences, as identified by survivors themselves, are support from supervisors and occupational health professionals, the positive attitude of coworkers, and workplace accommodations. Recent studies have shown the survivor’s perception of their employer’s accommodation for their cancer and its treatment to be predictive of return to work. Flexible and/or reduced work hours during treatment and a phased-in return once treatment is completed are key to formulating a successful plan to assist survivors in their recovery and prevent a premature exit from the workforce.
What the Oncology Team Can Do
Although we think of workplace issues as being between survivors and their employers, there are things we can do to help. First and foremost, education is critical. The survivor often needs assistance in understanding his/her rights as an employee under the Americans with Disabilities Act and may require support in asking for workplace accommodations. Guiding the survivor to set reasonable expectations for recovery after treatment can reduce stress and promote a successful dialogue with the employer.
In addition, communication between the oncology team and the employer about the survivor’s recovery can go a long way toward dispelling misinformation and reduce the likelihood of unrealistic demands. Such conversations can also foster employer sensitivity and provide understanding about the rationale for work adjustments so a flexible plan can be developed for the individual employee. Finally, clear and factual information can play a key role in ensuring good relations between the returned worker and his or her coworkers—an important ingredient since colleagues play such an important role in productivity and job satisfaction. ■
Disclosure: Ms. McCabe reported no potential conflicts of interest.
1. Mehnert A: Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol 77:109-130, 2011.
Ms. McCabe is Director of the Cancer Survivorship Initiative at Memorial Sloan-Kettering Cancer Center in New York.